Impact of a program combining pre-authorization requirement and post-prescription review of carbapenems: an interrupted time-series analysis.

The objective of this study was to assess the impact on carbapenems use of a program combining pre-authorization requirement and systematic post-prescription review of carbapenems prescriptions. The program was implemented in a 1,230-bed teaching tertiary hospital. Monthly carbapenems consumption was analyzed using a controlled interrupted time-series method and compared to that of vancomycin before and after implementation of the intervention. Compared to the pre-intervention period (14 monthly points), a significant and sustained decrease of carbapenems consumption [1.66 defined daily doses (DDD)/1,000 patient-days; p = 0.048] was observed during the intervention period (12 monthly points), despite an increasing trend in incidence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) isolates (0.02/1,000 patient-days per month; p = 0.093). As expected, vancomycin consumption was unaffected by the intervention. A total of 337 prescriptions were reviewed in the intervention period; most were microbiologically documented (81.3%; ESBL-PE: 39.2%). Three of four (76.6%) carbapenems prescriptions were modified within a median [interquartile range] of 2 [1; 4] days, either after infectious disease physician (IDP) advice (48.4%) or by ward physicians (28.2%). Most changes included de-escalating (52.2%) or reducing the planned duration (22.2%), which resulted in a median duration of treatment of only 3 [2; 7] days. The median length of stay and mortality rate were not influenced by the intervention. This reasonably practicable antimicrobial stewardship program including controlled delivery and systematic reevaluation of carbapenems prescriptions was able to reduce their use in our hospital, despite a rising ESBL-PE incidence.

Melatonin: experience in its use for recording sleep EEG in children and review of the literature.

BACKGROUND: Sleep is known to improve the yield of EEG recording in children but is often difficult to obtain. In order to evaluate the efficacy and to test the practicability of oral melatonin in obtaining sleep for EEG recording, we studied its use in 70 children. RESULTS: Sleep was obtained in 56 children (80%) with a mean sleep latency onset of 25 ± 7.9 min (15-45) after melatonin administration, and a mean sleep duration of 17.1 ± 8.6 min (5-55). 28 children (50%) woke up spontaneously after 13.2 ± 7.9 min (5-40). Among 18 children with severe behaviour problems that made interpretable EEG recording in the awake state impossible, sleep was obtained in 13 (72%) children. The rare symptoms reported (4%) were not reliably related to the use of melatonin. CONCLUSION: The study shows a very good efficacy in sleep induction for EEG recording, even in children with severe behaviour problems. Sleep duration was, however, short with a high proportion of spontaneous arousals but in all patients it was sufficient for an initial diagnosis or control of the evolution of epilepsy.